Just days after completing nursing school in 1995 in Hawaii courtesy of the U.S. Navy, Lovette Robinson got a new assignment. “I was ordered to San Diego to take the first Sexual Assault Nurse Examiner (SANE) class ever taught in the U.S. military.”
In the beginning, Robinson said, the idea of performing a sexual assault exam was terrifying. “But the idea of not providing care for sexual assault patients was more disturbing.”
SANEs are registered nurses who have completed specialized education and clinical preparation in the medical forensic care of the patient who has experienced sexual assault or abuse. They provide emotional support; physical examination; collection of medical-forensic evidence; assistance with reporting the crime to police when requested (mandatory reporting for children under age 17); assistance with concerns about sexually transmitted infection and pregnancy and post-assault physician ordered medication administration; assistance with planning for security and housing; and even provide fresh clothing following the examination. The SANE provider also receives comprehensive trial testimony training.
Robinson, whose credentials include APRN, BSN, SANE-A, CFN and CMI-II, had aspired to become an FBI agent. But after earning a Master’s degree in Forensic Sciences to improve her understanding of evidence-based processes of sexual assault examinations, she knew she’d found her calling.
“I realized I could make a difference helping people get the justice they deserve in my role as a SANE,” she said. She went on to establish three more SANE programs in the Navy and became a SANE instructor. After retiring from the Navy in 2009, she worked as the Sexual Assault Forensic Examiner Subject Matter Expert for the Navy Headquarters, Bureau of Medicine and Surgery.
Recruited as Supervisor of the new SANE Program at Parkland Health & Hospital System in 2015, Robinson has developed a team of four certified SANEs, 9 RNs in training and 4 nurses scheduled to enter training. Nurses in any specialty can apply. Parkland SANEs rotate on-call duty for SANE exams in addition to their regular jobs.
According to William Griffith, MD, Medical Director of Parkland’s SANE program, “Training involves two 40-hour classes, plus many hours of clinical and trial testimony training. It’s intensive and requires tremendous commitment. Parkland is fortunate to have such skilled and dedicated SANE nurses.”
As the nation observes Sexual Assault Awareness & Prevention Month during April, Parkland’s SANEs reflected on the importance of providing support to victims.
“SANES are often asked why we would volunteer for this difficult role,” said Deborah Bishop-Penn, BSN, RN, an ER nurse at Parkland. “I feel that as a SANE, I have another avenue to care for patients. While not all nurses can be a SANE and deal with the issue of sexual assault, I felt it was a good fit for me and how I want to contribute my nursing skills here at Parkland.”
“We see these patients at their most vulnerable,” said Angela Cox, BSN, RNC-MNN, CA-SANE, a transitional care case manager at Parkland. “Knowing I made a difference, however small, keeps me going. Sometimes it’s just being able to tell your patient ‘you did nothing wrong, it’s okay to take your time and say no or stop at any point during the examination.’ This is huge for survivors of sexual assault.”
Kelly Johnson, BSN, RNC-MNN, CA-SANE, a GYN oncology nurse, said that performing the SANE exam often takes many hours. “You have to build trust and rapport with the victim. It’s important to allow the sexual assault patient to have control during the exam process.”
However, time is of the essence in terms of requesting police investigation. Hayley Arnold, BSN, RN, CA-SANE, a nurse educator, explained, “From the time of the assault, we have 120 hours to complete an exam on a reported case (police involvement) versus 96 hours to complete an exam on a non-report case (no police involvement). Many patients don’t know this until we explain it to them.”
"On more than one occasion I have had a patient come in for an exam after the allotted time frame of 96 hours. This is heartbreaking for the patient and for the nurse,” Cox said. “But many victims can take days or months to get the courage to seek help. We are here for them, whenever they choose to come.”
“Sexual assault is an ugly reality and thousands of men, women and children are affected every year. SANEs have the unique ability to help victims immediately begin the healing process, regain a sense of control and – if they choose – seek justice through legal means,” Robinson said. “Sometimes the best care for these patients is to take time to listen and believe them in order to help make them whole again."
In 2015 in Dallas County, 2,082 cases of sexual assault were reported. The Texas Association Against Sexual Assault reports that 6.3 million Texans have experienced some form of sexual assault in their lifetime, 2 in 5 women and 1 in 5 men in Texas have been sexually assaulted and 91 percent of sexual assault victims did not report to law enforcement. Victims are male and female, children, elderly and every age between. Parkland provides SANE examinations for patients age 13 and up. In 2016, Parkland SANEs performed 360 rape kit exams and had 401 patient contacts.
Parkland provides victims of sexual assault the comprehensive services of the Victim Intervention Program (VIP)/Rape Crisis Center along with SANE examinations at Parkland’s ER. In addition to a 24-hour hotline, VIP/Rape Crisis Center support services include legal advocacy, court accompaniment, and assistance with specific victim resources including Crime Victims Compensation and community resources. In case of emergency, Dallas County Hospital District police officers respond to provide protection for victims and staff. Last year approximately 314 new clients received counseling services and 3,410 counseling hours were provided to victims.
“Sexual assault is a vastly under-reported crime,” said Melissa Reilly, LCSW, Director of the VIP/Rape Crisis Center. “There are many reasons, including fear, shame and guilt. But increased reporting improves law enforcement’s opportunity to identify and prosecute sex offenders. Our mission is to provide resources victims need to recover and assure their safety.”
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